Speech development- Delay and other problems

SPEECH DEVELOPMENT

Babu Appat

Language is the process whereby we communicate with others. It

involves an element of understanding and expression

(speech).

It is one of the most highly developed of all human skills,

giving us a framework for thought and allowing us to communicate

Disorders of speech and language are common, ranging from unclear

speech or a slight delay in development to more significant

difficulties associated with serious disorders

This presentation will give you an outline of the normal

development, assessment of the child presenting with these

difficulties and some of the more common causes

This presentation will give you an outline of the normal

development, assessment of the child presenting with these

difficulties and some of the more common causes

Normal speech development

The following is only a rough guide but there is a wide variation of normal speech development

1 to 6 months:

Turns to sound, startled by loud sounds, cooing and babbling sounds. Copies

smiles and laughs. Different sounds for different needs.

6 to 12 months:

Babbling initially 'da', 'ba' then combining syllables towards 7/8

months - da-da', 'ba-ba'

12 months:

says 'mama', 'dada' or another simple word with meaning

12 - 18 months:

vocabulary of 6-20 words, not necessarily understood by unfamiliar adults. Pretend play - for example,

pretending to talk on the phone

3-4 Years

Three to six words per sentence; asks and answers questions, relates

experiences, tells stories; almost all speech understood by strangers. Errors

with tense are normal - eg, 'runned' instead of 'ran'

4-5 Years

Six to eight words per sentence; names four colours; counts to ten

Variations in development versus

delay

It is important to clarify what the concern is, as

there can be a lot of variation in speech and language development

Consider whether either of the parents

was a late speaker

There tends to be a gender difference with girls developing slightly faster than boys and it is

traditionally said that bilingualism may delay speech

(although there is emerging evidence to the contrary

Parents are usually the first to express concern -

are they comparing to other children and simply

observing normal variation?

Examples of the need for referral include

There is no double syllable babble at a year.

There are fewer than six words, or there is persistent drooling, at 18 months

There are no two- to three- word sentences by 2½ years

Speech remains unintelligible by 4 years.

Epidemiology

Speech delay is a common childhood problem. It is estimated to affect around

6% of children.

However, this figure has been reported to be as high as 19%

The disorder is more common in boys than in girls.

• AetiologyPrimary• Primary speech and language delay. Delay is not caused by other conditions. Children have normal understanding, intellect, hearing, emotional relationships and articulation skills.• Expressive language disorder. Needs active intervention to improve.• Receptive language disorder.SecondaryProblems can arise from:• Speech or articulation difficulties:• Cleft lip• Tongue tie

Stammer

Cerebral palsy (can cause delay for several reasons)

Deafness.

Developmental problems:

Maturational delay (often familial)

Environmental deprivation and neglect

Learning disability

Communication difficulties:

Autism

Other

Selective mutism (the child selectively refuses to speak according to particular

circumstances)

Childhood apraxia of speech. Difficulty in making the right sounds in the correct

order.

Dysarthria. Motor difficulty in creating speech.

AssessmentThe questions to ask yourself are:

Is the child's hearing normal?Is this an articulation (speech) or

language problem?Is this an isolated problem or part of a

more global delay?Is there a communication disorder?

Assessment of the child to answer these questions can be complex - particularly beyond

toddlerhood - and a speech and language therapist assessment

may also be required

HistoryThese children may be

particularly shy about talking so obtain a good history from the

parents

Establish whether the child appears to have difficulty in hearing.Note whether the child seems to understand what the parent is saying. If they seem to understand, but respond with unintelligible speech, there is a speech problem. If there are comprehension difficulties too, there may be a language or other problem.Note whether there are delays in other physical or social skills which could suggest a more global delay.Establish whether there are abnormalities in nonverbal communication skills that might suggest autism.Obtain a complete developmental history.Check the past medical and perinatal history.Ask about a family history of deafness or language delay.

ExaminationObserve the child play and interact with the parent. Listen to any talking and note any imaginative play:A stammer is associated with normal comprehension; however, speech is immature, stuttered or unintelligible.Note that the ability to form interpersonal relationships is often normal in children with learning difficulties, as it is in all other causes except for autism.Autism and language disorders may both be associated with delays in other developmental areas.Ask the child simple questions about pictures or their play: note whether they seem to understand you. Assess motor and social skills.Note any anatomical abnormalities, and examine mouth and ears. Exclude tongue tie as a cause.

InvestigationsOrganise a formal hearing test by an audiologist. If you think that there is

some sort of language difficulty following your assessment, get a

speech and language evaluation too

ManagementManagement may sometimes be just explanation, simple advice and reassurance with the involvement of the health visitor.However, early detection and intervention for speech delay may prevent, or at least reduce, the educational, emotional and social problems that may be caused.A referral for speech therapy may be required. The effectiveness of therapy depends upon the cause for speech delay. There is some evidence for the effectiveness of interventions for expressive speech difficulties; the evidence for interventions for expressive syntax is mixed and there is no evidence for interventions for receptive language difficulties.[5]

There is currently no evidence for the best treatment of childhood apraxia of speech.[7] Also, there is no convincing evidence that speech and language therapy is effective for early acquired dysarthria.[8]

Multidisciplinary involvement may be required and the involvement of the parents is vital.Management is dependent on cause and associated problems such as hearing impairment.If the underlying problem is related to the auditory apparatus and surgery is required, children still need targeted language therapy to complete their rehabilitation.

Management

Management may sometimes be just explanation, simple advice and reassurance with the involvement of the health visitor.However, early detection and intervention for speech delay may prevent, or at least reduce, the educational, emotional and

social problems that may be caused.

Management

A referral for speech therapy may be required. The effectiveness of therapy depends upon the cause for speech delay. There is some evidence

for the effectiveness of interventions for expressive speech difficulties; the evidence for

interventions for expressive syntax is mixed and there is no evidence for interventions for

receptive language difficulties..

Management

There is currently no evidence for the best treatment of childhood apraxia of

speech. Also, there is no convincing evidence that speech and language therapy is effective

for early acquired dysarthria.Multidisciplinary involvement may be required

and the involvement of the parents is vital.

Management

Management is dependent on cause and associated problems such as hearing

impairment.If the underlying problem is related to the

auditory apparatus and surgery is required, children still need targeted language

therapy to complete their rehabilitation

There is no systematic child development and behaviour

screening policy in place as this was not recommended at the

last UK National Screening Committee (NSC) review. This is

currently under review

Prognosis

This is dependent on the cause of the speech delay.

The prognosis is improved with early detection and

intervention.

THANK YOU

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